Expert Views

The G-Standaard: A Best Practice from The Netherlands

Leonora Grandia is a pharmacist working for the Drug Information Centre, which is part of the Scientific Institute of the Royal Dutch Pharmaceutical Association (KNMP). Since 2005 she is Coordinator of the G-Standaard, and has responsibility for coordinating the different projects, collaborating with Z-Index (the publisher of the G-Standaard), and keeping in touch with the various software systems and users of the G-Standaard.

The origin of the G-Standaard was 25 years ago when Dutch pharmacists decided they needed a complete and accurate list of all medicinal products on the market. Since then, the G-Standaard has evolved into an indispensable source of data for the computerised processes of prescribing, ordering, medication surveillance, dispensing and reimbursement of medicinal products in The Netherlands. The system is being used by nearly all parties in healthcare.

“In my opinion, a key reason behind the success of the G-Standaard is that it was developed by practising pharmacists. Initially, the system was developed by a number of hospitals for local use. Later on the KNMP adopted the system and expanded it for nationwide use. As far as I know, the G-Standaard is unique in Europe.”

Multi-level structure

The G-Standaard consists of a central backbone with product information at different levels. A medicinal product is identified by more than 30 characteristics, such as active ingredient, pharmaceutical form, route of administration etc. Subsets of these characteristics form higher aggregation levels, representing a more ‘generic’ description of the drug. This multi-level structure has two main advantages.

“The higher aggregation levels enable efficient linkage of medication surveillance data. Furthermore, they allow pharmacists to support generic prescriptions, which can contribute to lower healthcare costs.”

Medication surveillance data

Medication surveillance plays an important role in prevention of medication errors, and several types of medication surveillance data are incorporated in the G-Standaard. These include drug interactions, contra-indications, unwanted co-prescriptions of drugs that are nearly similar, and dosage checks.

Most types of alerts are accompanied by practical guidelines on how to deal with the alert, alongside information about the mechanism and the clinical implications of for example the interaction or the contra-indication. This information is based on literature and is assessed by experts before entering the G-Standaard. Dosage checks cover age, body weight, indication and the daily/weekly dosage.

“If you know what happens when methotrexate is taken daily instead of weekly, such alerts can be life saving.”

Automatic medication surveillance has a great contribution to make to medication safety, as long as certain conditions are met.

“It is important to select only the most relevant alerts. If healthcare professionals are bombarded by too many alerts, they are likely to skip them all, and the benefits are lost. Furthermore, the practical guidelines must be as short and concrete as possible. For example, we have found that listing names of alternative drugs increases implementation of the guidelines.”

How to construct a drug database

“Numerous factors contribute to constructing a successful drug database. Firstly, I think that the drug database should be built by those who will actually work with it. Secondly, a hierarchical structure is essential. Without it you will miss the features necessary for medication surveillance, and thus miss an important benefit of a drug database.”

Another key factor is the national healthcare system. In The Netherlands, a patient will generally obtain his or her medicines primarily from one pharmacy. Consequently, a pharmacist has a fairly complete overview of the medicines used by his patients. In the absence of the Electronic Healthcare Record, a patient’s medication overview becomes indispensable for meaningful medication surveillance.

Finally, smooth cooperation between physicians and pharmacists is another important factor.

“Many medication surveillance data in the G-Standaard are based on the axiom that healthcare professionals communicate with each other. When that is not the case, alerts are of less benefit.”